Hamdan Medical Journal (previously the Journal of Medical Sciences)
|Table of Contents|
Catheter Ablation for Atrial Fibrillation: An Update
Atrial fibrillation (AF) is a common and increasingly prevalent arrhythmia associated with a significant burden on morbidity, mortality and healthcare expenditure. Catheter ablation for AF has evolved into a viable therapeutic option in select patients with symptomatic AF. Its development has been particularly promising given the suboptimal efficacy and risks associated with current rhythm control strategies. It offers an attractive alternative to maintaining sinus rhythm without the serious side effects associated with anti-arrhythmic drugs. Its superior efficacy over antiarrhythmic drugs in maintaining sinus rhythm has been demonstrated in several randomized controlled trials. Further studies are required to assess the long-term effects of catheter ablation for AF, especially its effect on stroke and mortality. The present paper will summarize the rationale for considering catheter ablation for AF, the evidence for its efficacy from controlled clinical trials, and future directions of research.
Fuster V, Ryden LE, Cannom DS, Crijns HJ, Curtis AB,Ellenbogen KA, et al. ACC/AHA/ESC 2006 Guidelines for the Management of Patients with Atrial Fibrillation: a report of the American College of Cardiology/American
Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Revise the 2001 Guidelines for the Management of Patients With Atrial Fibrillation): developed in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society. Circulation 2006; 114: e257-354.
Testa L, Biondi-Zoccai GG, Dello Russo A, Bellocci F, Andreotti F, Crea F. Rate-control vs. rhythm-control in patients with atrial fibrillation: a meta-analysis. Eur Heart J 2005; 26: 2000-6.
Wyse DG, Waldo AL, DiMarco JP, Domanski MJ, Rosenberg Y, Schron EB, et al. A comparison of rate control and rhythm control in patients with atrial fibrillation. N Engl J Med 2002; 347:1825-33.
Corley SD, Epstein AE, DiMarco JP, Domanski MJ, Geller N, Greene HL, et al. Relationships between sinus rhythm, treatment, and survival in the Atrial Fibrillation Follow-Up Investigation of Rhythm Management AFFIRM) Study. Circulation 2004; 109: 1509-13.
Calkins H, Brugada J, Packer DL, Cappato R, Chen SA, Crijns HJ, et al. HRS/EHRA/ECAS expert consensus
statement on catheter and surgical ablation of atrial fibrillation: recommendations for personnel, policy, procedures and follow-up. A report of the Heart Rhythm Society (HRS) Task Force on Catheter and Surgical Ablation of Atrial Fibrillation developed in partnership with the European Heart Rhythm Association (EHRA) and the European Cardiac Arrhythmia Society (ECAS); in collaboration with the American College of Cardiology (ACC), American Heart Association (AHA), and the Society of Thoracic Surgeons (STS). Endorsed and approved by the governing bodies of the American College of Cardiology, the American Heart Association, the European Cardiac Arrhythmia Society, the European Heart Rhythm Association, the Society of Thoracic Surgeons, and the Heart Rhythm Society. Europace 2007; 9: 335-79.
Haissaguerre M, Jais P, Shah DC, Takahashi A, Hocini M, Quiniou G, et al. Spontaneous initiation of atrial
fibrillation by ectopic beats originating in the pulmonary veins. N Engl J Med 1998; 339: 659-66.
Wazni OM, Marrouche NF, Martin DO, Verma A, Bhargava M, et al. Radiofrequency ablation vs antiarrhythmic drugs as first-line treatment of symptomatic atrial fibrillation: a randomized trial. JAMA 2005; 293: 2634-40.
Stabile G, Bertaglia E, Senatore G, De Simone A, Zoppo F, Donnici G, et al. Catheter ablation treatment in patients with drug-refractory atrial fibrillation: a prospective, multi-centre, randomized, controlled study (Catheter Ablation For The Cure Of Atrial Fibrillation Study). Eur Heart J 2006; 27: 216-21.
Oral H, Pappone C, Chugh A, Good E, Bogun F, Pelosi F Jr., et al. Circumferential pulmonary-vein ablation for chronic atrial fibrillation. N Engl J Med 2006; 354: 934- 41.
Pappone C, Augello G, Sala S, Gugliotta F, Vicedomini G, Gulletta S, et al. A randomized trial of circumferential pulmonary vein ablation versus antiarrhythmic drug therapy in paroxysmal atrial fibrillation: the APAF Study. J Am Coll Cardiol 2006; 48: 2340-7.
Cappato R, Calkins H, Chen SA, Davies W, Iesaka Y, Kalman J, et al. Worldwide survey on the methods,
efficacy, and safety of catheter ablation for human atrial fibrillation. Circulation 2005; 111: 1100-5.